Disorders of the Pancreas.

The pancreas is a vital intra-abdominal organ with dual exocrine and endocrine function. This article provides an overview of several common pancreatic pathologies including pancreatitis, pancreatic cysts, and pancreatic cancer with a focus on clinical presentation as well as initial diagnosis and management.

Cognitive Behavioral Therapy for Treatment of Insomnia in Primary Care for Resident Physicians.

Introduction: Insomnia is a common complaint among primary care patients that can have significant consequences for physiological and mental health. Although psychopharmacological interventions have traditionally been taught as first-line treatment in medical education, cognitive behavioral therapy (CBT) for insomnia has emerged as the recommended treatment to address the multimodal precipitants and reinforcing factors of insomnia symptoms. Methods: We developed a 90-minute workshop that included a didactic component to deliver content, role-playing to practice skills, and discussion to reflect and solidify learning. Two facilitators, a general internist and a clinical psychologist with content expertise in CBT, delivered the workshop to 16 internal medicine residents. This pairing provided complementary perspectives to allow for learner engagement. To evaluate the workshop, we used a pre/post survey that was administered at the beginning of the workshop and at its end. Participants were asked how often they incorporated (presurvey) and intended to incorporate (postsurvey) CBT as part of treatment of insomnia in their clinical practices. Results: Sixteen internal medicine residents participated in the workshop and completed the pre/post survey. Our results showed immediate positive outcomes as a result of participating in the workshop. Discussion: Our results showed that participants increased their intent to incorporate CBT in their primary care practice and increased their comfort with the various components of CBT. Our future directions include examining how long-term behavior changes as a result of this training.

Cognitive Behavioral Therapy and Pharmacotherapy for the Treatment of Tobacco Use Disorder in Primary Care for Resident Physicians.

Introduction: Though the prevalence of smoking has decreased, it remains the second leading risk for early death and disability worldwide. At the primary care level, the combined use of behavioral interventions and pharmacotherapy has been shown to be more effective in reduction of smoking. Among behavioral interventions, cognitive behavioral therapy (CBT) provides a useful framework for helping patients quit smoking. Methods: This 90-minute workshop was led by two facilitators, a general internist who practices as a primary care physician and a clinical psychologist with content expertise in CBT. This pairing provided complementary perspectives to allow for learner engagement. To evaluate the workshop, we used a pre-/postsurvey that was administered at the beginning and the end of the workshop. Participants were asked how often they incorporated (presurvey) and intended to incorporate (postsurvey) CBT as part of smoking cessation counseling in their clinical practices. Results: There was a statistically significant change in learners' perceived usefulness of CBT for smoking cessation from pre- to postworkshop. Discussion: Our workshop is a unique contribution to the literature. Limitations of our study include not knowing the long-term effect of knowledge acquisition or decay. Our future direction will be to produce training that applies CBT to other common chronic diseases that have a huge behavioral component in primary care, such as insomnia, chronic pain, and obesity.

Shape-Up and Eat Right Families Pilot Program: Feasibility of a Weight Management Shared Medical Appointment Model in African-Americans With Obesity at an Urban Academic Medical Center.

OBJECTIVES: Disparities in obesity care exist among African-American children and adults. We sought to test the feasibility of a pilot program, a 1-year family-based intervention for African-American families with obesity [shape up and eat right (SUPER)], adopting the shared medical appointment model (SMA) at an urban safety net hospital. OUTCOMES: Primary outcomes: (1) family attendance rate and (2) program satisfaction. Secondary outcomes: change in body mass index (BMI), eating behaviors, and sedentary activity. METHODS: Adult parents (BMI ≥ 25 kg/m2) ≥18 years and their child(ren) (BMI ≥ 85th percentile) ages 6-12 years from adult or pediatric weight management clinics were recruited. One group visit per month (n = 12) consisting of a nutrition and exercise component was led by a nurse practitioner and registered dietitian. Height and weight were recorded during each visit. Participants were queried on program satisfaction, food logs and exercise journals, Food Stamp Program's Food Behavior, and the Expanded Food and Nutrition Education Program food checklists. RESULTS: Thirteen participants from lower socioeconomic zip codes consented [n = 5 mothers mean age 33 years, BMI of 47.4 kg/m2 (31.4-73.6 kg/m2); n = 8 children; mean age 9 years, BMI of 97.6th percentile (94-99th percentile); 60% enrolled in state Medicaid]. Average individual attendance was 23.4% (14-43%; n = 13); monthly session attendance rates declined from 100 to 40% by program completion; two families completed the program in entirety. Program was rated (n = 5 adults) very satisfactory (40%) and extremely satisfactory (60%). Pre-intervention, families rated their eating habits as fair and reported consuming sugar-sweetened beverages or sports drinks, more so than watching more than 1 h of television (p < 0.002) or video game/computer activity (p < 0.006) and consuming carbonated sodas (p < 0.004). Post-intervention, reducing salt intake was the only statistically significant variable (p < 0.029), while children watched fewer hours of television and spent less time playing video games (from average 2 to 3 h daily; p < 0.03). CONCLUSION: Attendance was lower than expected though children seemed to decrease screen time and the program was rated satisfactory. Reported socioeconomic barriers precluded families from attending most sessions. Future reiterations of the intervention could be enhanced with community engagement strategies to increase participant retention.